PB2565: TRANSFUSIONAL IRON OVERLOAD AND ASSOCIATED COMPLICATIONS IN HEMATOLOGY DISORDERS PATIENTS
Authors: Nikolay Romanenko, Elena Shilova, Daria Lastochkina, Sergei Gritsaev
Journal: HemaSphere (2023)

Topic: 29. Iron metabolism, deficiency and overload Background: Transfusions of red blood cells (RBC) are prescribed for correction of anemia in patients with oncological and hematological profile. However, multiple transfusions may lead to side effects as iron overload (IO). Among the most susceptible patients to IO are aplastic anemia (AA), myelodysplastic syndrome (MDS), primary myelofibrosis (PMF), thalassemia. Aims: To find out the frequency of transfusional IO and associated complications in patients received multiple RBC transfusions. Methods: In this study were included patients with AA (n = 117) aged 19-67 years (y.) (Me = 36 y.; younger than 60 y. – 93.1%), MDS (n = 239) aged 43-90 y. (Me = 66.5 y.; younger 60 y. – 42.7%), PMF (n = 35) aged 51-83 y. (Me = 67 y.; younger 60 y. – 28.6%), β-thalassemia (n=78) aged 18-63 y. (Me = 28 y.; younger 60 y. – 98.7%); they received at least 4 units (U) of RBC. The severity of IO was assessed according to the level of serum ferritin (SF): mild – 1000-2000 ng/ml, medium – 2000-4000 ng/ml, severe - > 4000 ng/ml. Results: Patients with AA received from 5 to 134 U of RBC, ≥ 20 transfusions were performed in 70.9% of patients. IO (SF ≥ 1000 ng/ml) was detected in 55.4% of patients: mild IO was in 17.9%, average – in 23.9%, severe – in 13.6%. In patients transfused < 20 U the SF was 319 ± 56 ng/ml (21–1002 ng/ml), whom received ≥ 20 U the SF was higher – 2950 ± 208 (498-11810 ng/ml; p < 0.001). Patients with MDS received 4–164 U of RBC, ≥ 20 U transfused to 59.4% of patients. IO was detected in 63.5%: mild degree was noted in 21.5%, average – in 20.8%, severe – in 21.2%. Patients who received < 20 U of RBC, the SF was of 590 ± 67 ng/ml (24-1410 ng/ml), patients who received ≥ 20 U an SF was 2920 ± 79 (810-9801; p < 0.001). Patients with PMF were performed 5–181 transfusions, ≥ 20 U received 62.9% of patients. IO was detected in 65.8%: mild degree was established in 37.2%, medium – in 14.3%, severe – in 14.3%. Patients who were transfused < 20 U, the SF was of 612 ± 99 ng/ml (108-1104 ng/ml), and patients who received ≥ 20 U, the SF was – 2808 ± 288 (1012–6560; p < 0.001). β-thalassemia patients received 4–764 U of RBC, ≥ 20 transfusions were in 57.7% of patients. The SF ≥ 1000 ng/ml was detected in 57.7% of cases. Mild degree of iron overload was found in 12.8% of patients, average – in 15.4%, severe – in 29.5%. In patients with low transfusion load (< 20 U), the SF was 3290 ± 44 ng/ml (39-1163 ng/ml), who received ≥ 20 U, the SF was 1978 ± 187 (339-14063 ng/ml; p < 0.001). The analysis of complications associated with transfusional IO showed AA patients had significantly more frequent disorders of cardiovascular system (24.8%) and liver (22.2%) in compared with pathology of immune (12.8%) or endocrine systems (7.7%). In MDS, the pathology of immune system (30.4%) and cardiovascular system (20.1%) prevailed over the pathology of liver (14.0%) and endocrine system (5.8%). Similar results were observed in PMF – changes in cardiovascular (62.9%) and immune system (40%) were more detected compared to pathology of liver (22.9%) and endocrine system (20.0%). However, in β-thalassemia patients liver pathology was more common (54.7%) compared with dysfunction of cardiovascular (35.9%), endocrine (30.8%) and immune systems (19.2%). Summary/Conclusion: The results indicate high frequency of transfusional IO in the groups of patients who received ≥ 20 U of RBC. Complications associated with IO were found more often in cardiovascular, immune system and liver, less – in endocrine system. Keywords: Thalassemia, Iron overload, Aplastic anemia, MDS